I feel it is important to have an understanding of the various types of infections that we face with lymphoedema.These infections include
cellulitis, lymphangitis, and erysipelas.

One must remember that every infection we have further damages our lymphatics, thus leading to more severe lymphoedema. Untreated infection will lead to sepsis (commonly refered to as blood poisoning), gangrene which involves loss of limb and/or eventual death.

In treating any type of infection, the doctor not only must identify the type of bacteria involved, but must understand the staging of lymphoedema and the differences in the tissue types of the stages.

Heavily fibrotic lymphoedema limbs are exceedingly difficult to treat
because the denseness of the tissue impeeds or even can prevent the chosen antibiotic from reaching the bacteria. In this situation
long term IV antibiotic thereapy should be considered.

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Cellulitis

Cellulitis is an acute inflammation of the connective tissue of the skin, caused by infection with staphylococcus, streptococcus or other bacteria.

See the Lymphedema Cellulitis and Lymphangitis Section for more comprehensive information.
Cellulitis

Acute Cellulitis is one of the complications of lymphoedema. The patient may not be aware of the source of the etiology. Sometimes it may be a cut, mosquito bite, open wound or other infection in the body.

The first sign is increased or different quality of PAIN involving the lymphoedema limb. The patients often describe this as a "flu like symptom or an ache" involving the lymphoedema arm or leg. This is usually followed by sudden onset of ERYTHEMA(redness, red streaks or blotches) on the involved limb. The HYPERTHERMIA(lymphoedema limb becomes warm, hot) will follow and the patient may experience the CHILLS and even HIGH FEVER.

The early intervention and treatment with antibiotics will resolve this condition (it usually takes a very minimum ten day course of antibiotics). Only a Medical Doctor will be able to prescribe the Antibiotics, thus a consultation with a Doctor is necessary. Severe Cellulitis may require Inter venous Antibiotic treatment and hospitalization. Again, elevation of the affected limb is important.

During that phase the patient should NOT massage the lymphoedema limb, bandage, apply the pump, wear tight elastic sleeve or exercise excessively. Avoid the blood pressure and blood to be drawn from the involved arm. Keep the limb elevated as much as possible while resting. Once the symptoms dissipate the treatment MLD/CDP should be initiated.

How do we prevent this infection? The patient should be careful with daily activities and take all precautions to protect the skin (wear gloves when gardening, cleaning with detergents, etc... ). If an injury to skin occurs on the lymphoedema limb it is necessary to clean the wound with alcohol or hydrogen peroxide and apply Neosporin/Polysporin antibiotic ointment. If the symptoms progress seek the attention of a physician immediately.

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Lymphadenitis and lymphangitis

Lymphangitis is an inflammation of one or more lymphatic vessels. Generally caused by an acute streptoccocal infection from an insect bite,animal bite of wound. Fine red streaks may extend from the infected area to the armpits or groin. Other signs and symptoms include fever, chills, headache, or muscle ache.

Immediate treatment is required to prevent the infection spreading into the blood stream thereby becoming septic. Treatment is with antibiotic therapy.

Lymphangitis

Lymphangitis involves the lymph vessels/channels, with inflammation of the channel and resultant pain and systemic and localized symptoms. It commonly results from an acute streptococcal or staphylococcal infection of the skin (cellulitis), or from an abscess in the skin or soft tissues.

Lymphangitis may suggest that an infection is progressing, and should raise concerns of spread of bacteria to the bloodstream, which can cause life-threatening infections. Lymphangitis may be confused with a clot in a vein (thrombophlebitis).

Symptoms

red streaks from infected area to the armpit or groin
may be faint or obvious
throbbing pain along the affected area (common)
may involve the lymph nodes (see above)
fever of 100 to 104 degrees Fahrenheit and/or chills
individuals may have a general ill feeling (malaise), with loss of appetite, headache, and muscle aches

Lymph node enlargement from edema and WBC cellular infiltration, the major sign of lymphadenitis, may be asymptomatic or may cause pain and tenderness. With some infections the overlying skin is inflamed, occasionally with cellulitis; abscess formation may occur, and penetration to the skin will produce draining sinuses.

Lymphadenitis and its cause are usually clinically apparent. Occasionally, however, lymph node aspiration and culture or excisional biopsy is necessary.

Lymphadenitis is the inflammation of a lymph node. It is often a complication of a bacterial infection of a wound, although it can also be caused by viruses or other disease agents. Lymphadenitis may be either generalized, involving a number of lymph nodes; or limited to a few nodes in the area of a localized infection. Lymphadenitis is sometimes accompanied by lymphangitis, which is the inflammation of the lymphatic vessels that connect the lymph nodes.

Description

Lymphadenitis is marked by swollen lymph nodes that are painful, in most cases, when the doctor touches them. If the lymphadenitis is related to an infected wound, the skin over the nodes may be red and warm to the touch. If the lymphatic vessels are also infected, there will be red streaks extending from the wound in the direction of the lymph nodes. In most cases, the infectious organisms are hemolytic Streptococci or Staphylococci. Hemolytic means that the bacteria produce a toxin that destroys red blood cells.

The extensive network of lymphatic vessels throughout the body and their relation to the lymph nodes helps to explain why bacterial infection of the nodes can spread rapidly to or from other parts of the body. Lymphadenitis in children often occurs in the neck area because these lymph nodes are close to the ears and throat, which are frequent locations of bacterial infections in children.

Causes and symptoms

Streptococcal and staphylococcal bacteria are the most common causes of lymphadenitis, although viruses, protozoa, rickettsiae, fungi, and the tuberculosis bacillus can also infect the lymph nodes. Diseases or disorders that involve lymph nodes in specific areas of the body include rabbit fever (tularemia), cat-scratch disease, lymphogranuloma venereum, chancroid, genital herpes, infected acne, dental abscesses, and bubonic plague. In children, tonsillitis or bacterial sore throats are the most common causes of lymphadenitis in the neck area. Diseases that involve lymph nodes throughout the body include mononucleosis, cytomegalovirus infection, toxoplasmosis, and brucellosis.

The early symptoms of lymphadenitis are swelling of the nodes caused by a buildup of tissue fluid and an increased number of white blood cells resulting from the body's response to the infection. Further developments include fever, often as high as 101-102°F (38-39°C) together with chills, loss of appetite, heavy perspiration, a rapid pulse, and general weakness.

Diagnosis

Physical examination

The diagnosis of lymphadenitis is usually based on a combination of the patient's history, the external symptoms, and laboratory cultures. The doctor will press (palpate) the affected lymph nodes to see if they are sore or tender. Swollen nodes without soreness are often caused by cat-scratch disease. In children, the doctor will need to rule out mumps, tumors in the neck region, and congenital cysts that resemble swollen lymph nodes.

Although lymphadenitis is usually diagnosed in lymph nodes in the neck, arms, or legs, it can also occur in lymph nodes in the chest or abdomen. If the patient has acutely swollen lymph nodes in the groin, the doctor will need to rule out a hernia in the groin that has failed to reduce (incarcerated inguinal hernia). Hernias occur in 1% of the general population; 85% of patients with hernias are male.

Laboratory tests

The most significant tests are a white blood cell count (WBC) and a blood culture to identify the organism. A high proportion of immature white blood cells indicates a bacterial infection. Blood cultures may be positive, most often for a species of staphylococcus or streptococcus. In some cases, the doctor may order a biopsy of the lymph node.

Treatment

Medications

The medications given for lymphadenitis vary according to the bacterium or virus that is causing it. If the patient also has lymphangitis, he or she will be treated with antibiotics, usually penicillin G (Pfizerpen, Pentids), nafcillin (Nafcil, Unipen), or cephalosporins. Erythromycin (Eryc, E-Mycin, Erythrocin) is given to patients who are allergic to penicillin.

Supportive care

Supportive care of lymphadenitis includes resting the affected limb and treating the area with hot moist compresses.

Surgery

Cellulitis associated with lymphadenitis should not be treated surgically because of the risk of spreading the infection. Pus is drained only if there is an abscess and usually after the patient has been started on antibiotic treatment. In some cases, a biopsy of an inflamed lymph node is necessary if no diagnosis has been made and no response to treatment has occurred.

Prognosis

The prognosis for recovery is good if the patient is treated promptly with antibiotics. In most cases, the infection can be brought under control in three or four days. Patients with untreated lymphadenitis may develop blood poisoning (septicemia), which is sometimes fatal.

An bacterial infection of the skin beginning as a redness and progressing to itching, blisters, breakdown of the skin, and honey-colored crusts. Lesions usually form on the face and spread locally. The disorder is highly contagious by contact with the discharge from the lesions. Acute kidney trouble is an occasional complication. Treatment includes thorough cleansing with antibacterial soap and water, compresses, removal of crusts and use of systemic antibiotics. Treatment is essential to prevent spread of infection.

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Impetigo

Definition:

Impetigo is a skin disorder caused by bacterial infection and characterized by crusting skin lesions.

Causes, incidence, and risk factors

Impetigo is a common skin infection. It is most common in children, particularly children in unhealthy living conditions. In adults, it may follow other skin disorders. Impetigo may follow a recent upper respiratory infection such as a cold or other viral infection. It is similar to cellulitis, but is more superficial, involving infection of the top layers of the skin with streptococcus (strep), staphylococcus (staph), or both.

The skin normally has many types of bacteria on it, but intact skin is an effective barrier that keeps bacteria from entering and growing within the body. When there is a break in the skin, bacteria can enter the body and grow there, causing inflammation and infection. Breaks in the skin may occur with insect bites, animal bites, or human bites; or other injury or trauma to the skin. Impetigo may occur on skin where there is no visible break.

Impetigo begins as an itchy, red sore that blisters, oozes and finally becomes covered with a tightly adherent crust. It tends to grow and spread. Impetigo is contagious. The infection is carried in the fluid that oozes from the blisters. Rarely, impetigo may form deeper skin ulcers.

Symptoms

Skin lesion on the face/ lips, or on the arms or legs, spreading to other areas. Typically this lesion begins as a cluster of tiny blisters which burst, followed by oozing and the formation of a thick honey or brown colored crust that is firmly stuck to the skin.

Itching blister:

Filled with yellow or honey-colored fluid

Oozing and crusting over

Rash (may begin as a single spot, but if child digs at it, it may spread to other areas).

In infants, a single or possibly multiple blisters filled with pus, easy to pop and when broken leave a reddish raw-looking base.

Lymphadenopathy -- local lymph nodes near the infection may be swollen.

Signs and tests

Diagnosis is based primarily on the appearance of the skin lesion. A culture of the skin or mucosal lesion usually grows streptococcus or staphylococcus.

Treatment

The goal is to cure the infection and relieve the symptoms.

A mild infection is typically treated with a prescription antibacterial cream such as Bactroban. Oral antibiotics (such as erythromycin or dicloxacillin) are also frequently prescribed and result in rapid clearing of the lesions.

Wash the skin several times a day, preferably with an antibacterial soap, to remove crusts and drainage.

Prevent the spread of infection. Use a clean washcloth and towel each time. Do not share towels, clothing, razors, and so on with other family members. Wash the hands thoroughly after touching the skin lesions.

Expectations (prognosis)

The sores of impetigo heal slowly and seldom scar. The cure rate is extremely high, but they often come back in young children.

Complications

The infection could spread to other parts of the body. This is common.

Children often have multiple patches of impetigo.
A systemic infection could lead to kidney failure (post-streptococcal glomerulonephritis). This is a rare occurrence.
Permanent skin damage and scarring (also extremely rare).

Prevention

Good general health and hygiene help to prevent infection. Minor abrasions or areas of damaged skin should be thoroughly cleansed with soap and clean water. A mild antibacterial agent may be applied if desired.

Impetigo is contagious, so avoid skin contact with drainage from impetigo lesions.

Extractions: Cat-scratch disease (benign lymphoreticulosis) Â– infectious disease associated with a history of scratches, bites from or close contact with a cat. The infecting agent is Bartonella henselae a tiny bacillus of familia Chlamydiae. The host and the source of infection are cats, with the infection agent being a normal part of their mouth flora. Person-to-person transmission of the disease has not been shown. The infection enters through skin wounds causing inflammation. Carried by lymph the infection reaches the nearest lymph node causing its inflammation too. Further the infection spreads with the bloodstream over the system. After convalescence the body develops persistent immunity to the disease. Treating cat-scratch disease (lymphoreticulosis). Symptoms of cat-scratch disease . Incubation period lasts from 3 to 20 days. A small, slightly elevated stain, slightly painful with a red rim appears in the place of the healed scratch or bite, turning in 2-3 days into a vesicle filled with a turbid content. The vesicle is then replaced by a small ulceration or crust. In several days after the scratch was inflicted the nearest lymph node gets enlarged. At this time the patient may complain of a headache, malaise, temperature. In some cases temperature may rise to 38-39 C and be associated with morning-night fluctuations and sweating, though in 7-10 days the temperature drops back to normal or slightly above. Sometimes the fever becomes tidal. Rarely high temperature may persist for 5-6 months and longer. Sometimes the disease progresses without temperature rise. The affected lymph node after reaching its maximum slowly diminishes, seldom purulent maturations end up with spontaneous opening and pus discharge.

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Cutaneous Abscesses

Alternative Names

abscess - skin; cutaneous abscess; subcutaneous abscess

Definition

A collection of pus and infected material in or on the skin

Causes, Risk Factors Incidence

Skin abscesses are fairly common. They are caused when a localized infection causes pus and infected material to collect in the skin or subcutaneous tissue. Skin abscesses may follow a bacterial infection, commonly an infection with staphylococcus (staph aureus is most common). They can develop after a minor wound, injury, or as a complication of folliculitis or boils (furuncles, carbuncles). Skin abscesses may occur anywhere on the body. They affect people of all ages.

The abscess can obstruct and impinge on the functioning of deeper tissues. The infection may spread locally or systemically. The spread of infection through the bloodstream may cause severe complications.

Prevention

Prevent and watch for bacterial infections. Keep the skin around minor wounds clean and dry. Consult the health care provider if you develop signs of infection, including fever, pain, redness, localized swelling, or drainage that looks like pus or is bloody.

Treat superficial (minor) infections promptly.

Symptoms

skin lesion
open sore or nodule
reddened
may drain fluid
localized swelling, induration
affected area is tender to touch
Signs and Tests
The diagnosis is based on the appearance of the area.

Culture of drainage from the lesion may reveal the causative organism.

Treatment

The goal of treatment is the cure of the infection.

Surgical incision and drainage of the abscess, with or without packing for 24 to 48 hours, cleans the area and allows infection to be controlled. Some skin abscesses may be drained in the health care provider's office.

localized spread of infection
impingement on the functioning of adjacent structures
gangrene (tissue death)
systemic spread of infection causing:
endocarditis
osteomyelitis
multiple new abscesses ("seeding" of infection)
abscess formation on the joints, pleura, or other locations

Call you doctor if

Call for an appointment with your health care provider if symptoms indicate skin abscess is present.

Call for an appointment with your health care provider if signs of superficial skin infection occur, including fever, pain, redness, localized swelling, drainage that looks like pus or is bloody.

Also call for an appointment with your health care provider if new symptoms develop during or after treatment for skin abscess.

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Scalded Skin Syndrome

Skin infection caused by staphlococcal bacteria. Appearance is
characterised by red peeling skin. It is causd by the release of two toxins (epidermolytic toxins A and B) of from toxigenic strains of the bacteria Staphylococcus aureus.